title: [CLIPPERS syndrome with atypical distribution of lesions in magnetic resonance imaging of the brain].
abstract: BACKGROUND
  CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory process of the central nervous system whose distinguishing features are the enhancing punctiform lesions in the brainstem that appear in the magnetic resonance images. Clinically, it is accompanied by dysarthria, ataxia and diplopia, and usually responds to treatment with corticoids. Pathologically, T lymphocytes appear infiltrated in the perivascular spaces of the brainstem.
  
  
  METHODS
  We report the case of a 40-year-old woman with an initial subacute clinical picture of binocular diplopia, ataxia and dysarthria. The magnetic resonance brain scan revealed T2 hyperintense punctiform lesions in the stem, cerebellum, diencephalons and cortico-subcortical areas of both hemispheres, which were enhanced with contrast. An aetiological study was performed to rule out any underlying infectious, neoplastic or inflammatory origin, the results being negative. The patient was treated on two occasions with methylprednisolone, with a gradual lowering of the dosage, the response being favourable.
  
  
  CONCLUSIONS
  Diplopia and ataxia, as in our case, are practically always present. The MR findings consist of punctiform enhancing lesions located in the pons extending towards the cerebellum, basal ganglia and corpus callosum, the enhancement gradient becoming lower as the distance increases rostrally away from the cortex, and caudally towards the spinal cord. In the case of our patient, this gradient is not respected, and the density found was similar to that of lesions at the supratentorial level. The differential diagnosis is wide-ranging and justifies an extensive diagnostic study with, in certain cases, a biopsy study of brain tissue. The disease courses in a relapsing-remitting pattern and the earlier steroid therapy is established and the more prolonged it is, the better the prognosis will be.
authors.affiliation: Hospital Universitario de la Princesa, 28006 Madrid, Espana.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Canneti
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Mosqueira
authors.forename: Francisco
authors.initials: F
authors.lastname: Gilo
authors.forename: Teresa
authors.initials: T
authors.lastname: Carreras
authors.forename: Antonio
authors.initials: A
authors.lastname: Barbosa
authors.forename: Virginia
authors.initials: V
authors.lastname: Meca-Lallana
authors.forename: José
authors.initials: J
authors.lastname: Vivancos
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D002531:Cerebellum / Q000473:pathology; D004172:Diplopia / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004401:Dysarthria / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004660:Encephalitis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D059906:Neuroimaging; D011149:Pons / Q000473:pathology; D012008:Recurrence; D013577:Syndrome
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone